Stroke differential diagnosis and mimics: Part 1

Hippocampal formation. Most patients with anti-NMDAR encephalitis develop a multistage illness that progresses from psychosis, memory deficits, seizures, and language disintegration into a state of unresponsiveness with catatonic features often associated with abnormal movements, and autonomic and breathing instability. Structures within the MTL, and particularly the hippocampus, have distinct functions in combining information from multiple cortical streams, supporting our ability to encode and retrieve details of events that compose episodic memories. A number of viruses seem to preferentially target this area, such as the herpes simplex virus (HSV). NINDS supports and conducts research on neurobehavioral disorders such as Klüver-Bucy syndrome. The HSV-1 and HSV-2 viruses are further subcategorized as Alphaherpesvirinae based on various characteristics that establish how they will manifest as disease in humans (Halperin, 2007). RESULTS: Thirty-three of 42 patients (78.6%) demonstrated enlargement and T2 hyperintensity of mesial temporal lobe structures at some time point.

There was additional damage to the left insular cortex and its surrounding structures but no evidence of frontal lobe damage on MRIs or cognitive tests. DWI shows variable signal, typically with increased ADC values. 2016. In general, young children, older adults, and people who have impaired immune systems are at the greatest risk of serious illness, permanent neurological problems (such as seizures, memory loss, personality changes, or intellectual disability), or death as a result of encephalitis. Nevertheless, both subacute infarcts with hemorrhage and high-grade hemorrhagic gliomas can show areas of restricted diffusion, heterogeneous enhancement and mass effect that can be indistinguishable. The amount of protein is usually elevated and the amount of glucose low. But the fact is that the brain is such a delicate organ, and easily affected.

But I needed to first deal with all this OTHER stuff first. Patients present with altered mental status, memory impairment, ophthalmoplegia or ataxia. However, even a negative brain biopsy does not rule out isolated CNS vasculitis (Chu et al. For viral/herpetic encephalitis, intravenous acyclovir is the mainstay agent, and steroids are usually avoided. There was hyponatraemia due to syndrome of inappropriate secretion of antidiuretic hormone (SIADH), and raised C‐reactive protein and gamma‐glutaryltranspeptidase levels. Stroke mimics are common in the emergency department and some of these patients may be treated with intravenous tPA. Despite many clinical and imaging overlaps, a pattern-based approach provides a reasonably accurate method to diagnose of many of these conditions and facilitate appropriate and timely management.